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Droopy Eyelids?

Learn About Treatments That Improve Vision and Appearance

Mamta Shah, MDBy: Mamta V. Shah, MD, Oculoplastic Surgeon, CareMount Medical
January 28, 2021

Our eyes are thought to be our most effective means of nonverbal communication. They are also one of the most sincere parts of the face because they convey our emotions honestly and often times involuntarily. But what if droopy upper eyelids cover your eyes or hinder your vision preventing you from seeing the eyes of others?

Droopy upper eyelids can both impede this nonverbal communication and can block vision, creating serious safety and quality of life issues. Droopy eyelids may not be functionally bothersome but rather an aesthetic or cosmetic concern. They can impact a person’s appearance making him or her look tired, sleepy, or older than he or she may be.

Droopy eyelids that limit or block vision should be diagnosed and managed by a medical professional. Symptoms include:
• Complaints of not being able to see the upper part of the visual field;
• Forehead ache from increased effort needed to raise the eyelids;
• Needing to tilt the head back or lifting the eyelid with a finger to see from under the eyelid;
• Eye strain and eye fatigue, especially when reading.

A thorough knowledge of the delicate upper eyelid anatomy helps diagnose each patient’s specific concern. A group of muscles work in synchrony to open and close the eyelids during one, single blink. Good eyelid closure keeps moisture in and prevents the ocular surface from drying out or being exposed to harmful toxins in the environment. A specific upper eyelid muscle, known as the levator muscle plays a large role in opening the eyelid and keeping it open.

Age-related skin changes, sun exposure, and gravity over many years can take their toll on the levator muscle causing it to separate from its insertion on the eyelid, which leads to “ptosis,” one of the several causes of a droopy upper eyelid. Other causes of ptosis include:
• Hereditary ptosis
• Excessive eye rubbing
• Traumatic injury to the nerve that stimulates the levator muscle or to the muscle itself
• Cataract surgery
• Stroke, tumors or diseases such as myasthenia gravis

Normal age-related loss of skin elasticity and weakening of the connective tissue of the upper eyelid may also lead to an appearance of excess or redundant upper eyelid skin that “weighs” the eyelid down, touches the lid’s margin and/or eyelashes, and in some cases causes a “hooding” effect on the lid. This is called “dermatochalasis,” another cause of a droopy upper eyelid.
Whether you are bothered by the appearance of droopy eyelids or are experiencing functional vision impairment, it is important to know that both ptosis and dermatochalasis are treatable. Your primary care physician can recommend a specialist known as an “oculoplastic surgeon” who will conduct a thorough examination to determine the cause of your droopy eyelid(s) and, depending upon severity, recommend either surgical or non-surgical treatment options.

For severe ptosis, surgery is usually recommended to strengthen and tighten the levator muscle to improve the field of vision and appearance. For dermatochalasis, surgery involves removing the causative upper eyelid skin in a manner that still allows for good eyelid closure, cosmesis, and symmetry between both eyelids. These are usually outpatient procedures with a return to home on the same day. Recovery is variable, but for most patients, it takes about one to two weeks. Minor bruising or swelling can be expected and will likely resolve during that time.

In considering ptosis surgery, patients should understand that even the most skilled surgeon cannot control all the variables that determine the final position of the eyelid. It’s possible the eyelid will be higher or lower than desired, which can be revised at a later point once swelling has resolved. The vast majority of patients are pleased with the improved position of their lid(s) and their appearance. As with any surgery there is potential risk for occurrence of complications such as bleeding and infection, though this is uncommon. Be sure to tell your surgeon about any blood-thinning medications you are on and a detailed medical history.

 

Dr. Mamta Shah is an oculoplastic surgeon, board-certified by the American Board of Ophthalmology. She completed her medical degree at Boston University School of Medicine, and her residency in Ophthalmology at SUNY Downstate Medical Center in Brooklyn, NY. Dr. Shah completed an Ophthalmic Plastic and Reconstructive Surgery fellowship at Allegheny Health Network in Pittsburgh, PA. She practices at CareMount Medical’s Mount Kisco campus and at Putman Hospital Center and she is affiliated with Northern Westchester Hospital.